scholarly journals Hospital nurse staffing and staff–patient interactions: an observational study

2019 ◽  
Vol 28 (9) ◽  
pp. 706-713 ◽  
Author(s):  
Jackie Bridges ◽  
Peter Griffiths ◽  
Emily Oliver ◽  
Ruth M Pickering
Keyword(s):  
Nurse Staffing ◽  
Care Quality ◽  
Multilevel Regression ◽  
Negative Interaction ◽  
Skill Mix ◽  
Staffing Levels ◽  
Patient Interactions ◽  
Number Of Patients ◽  
The Relationship

BackgroundExisting evidence indicates that reducing nurse staffing and/or skill mix adversely affects care quality. Nursing shortages may lead managers to dilute nursing team skill mix, substituting assistant personnel for registered nurses (RNs). However, no previous studies have described the relationship between nurse staffing and staff–patient interactions.SettingSix wards at two English National Health Service hospitals.MethodsWe observed 238 hours of care (n=270 patients). Staff–patient interactions were rated using the Quality of Interactions Schedule. RN, healthcare assistant (HCA) and patient numbers were used to calculate patient-to-staff ratios. Multilevel regression models explored the association between staffing levels, skill mix and the chance of an interaction being rated as ‘negative’ quality, rate at which patients experienced interactions and total amount of time patients spent interacting with staff per observed hour.Results10% of the 3076 observed interactions were rated as negative. The odds of a negative interaction increased significantly as the number of patients per RN increased (p=0.035, OR of 2.82 for ≥8 patients/RN compared with >6 to <8 patients/RN). A similar pattern was observed for HCA staffing but the relationship was not significant (p=0.056). When RN staffing was low, the odds of a negative interaction increased with higher HCA staffing. Rate of interactions per patient hour, but not total amount of interaction time, was related to RN and HCA staffing levels.ConclusionLow RN staffing levels are associated with changes in quality and quantity of staff–patient interactions. When RN staffing is low, increases in assistant staff levels are not associated with improved quality of staff–patient interactions. Beneficial effects from adding assistant staff are likely to be dependent on having sufficient RNs to supervise, limiting the scope for substitution.

scholarly journals Nurse staffing and patient-perceived quality of nursing care: a cross-sectional analysis of survey and administrative data in German hospitals

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e051133
Author(s):  
Vera Winter ◽  
Karina Dietermann ◽  
Udo Schneider ◽  
Jonas Schreyögg
Keyword(s):  
Nursing Care ◽  
Nurse Staffing ◽  
Perceived Quality ◽  
Secondary Outcome ◽  
Skill Mix ◽  
Staffing Levels ◽  
Hospital Units ◽  
The Impact ◽  
Quality Of Nursing

ObjectiveTo examine the impact of nurse staffing on patient-perceived quality of nursing care. We differentiate nurse staffing levels and nursing skill mix as two facets of nurse staffing and use a multidimensional instrument for patient-perceived quality of nursing care. We investigate non-linear and interaction effects.SettingThe study setting was 3458 hospital units in 1017 hospitals in Germany.ParticipantsWe contacted 212 554 patients discharged from non-paediatric, non-intensive and non-psychiatric hospital units who stayed at least two nights in the hospital between January and October 2019. Of those, 30 174 responded, yielding a response rate of 14.2%. Our sample included only those patients. After excluding extreme values for our nurse staffing variables and removing observations with missing values, our final sample comprised 28 136 patients ranging from 18 to 97 years of age (average: 61.12 years) who had been discharged from 3458 distinct hospital units in 1017 hospitals.Primary and secondary outcome measuresPatient-perceived quality of nursing care (general nursing care, guidance provided by nurses, and patient loyalty to the hospital).ResultsFor all three dimensions of patient-perceived quality of nursing care, we found that they significantly decreased as (1) nurse staffing levels decreased (with decreasing marginal effects) and (2) the proportion of assistant nurses in a hospital unit increased. The association between nurse staffing levels and quality of nursing care was more pronounced among patients who were less clinically complex, were admitted to smaller hospitals or were admitted to medical units.ConclusionsOur results indicate that, in addition to nurse staffing levels, nursing skill mix is crucial for providing the best possible quality of nursing care from the patient perspective and both should be considered when designing policies such as minimum staffing regulations to improve the quality of nursing care in hospitals.

scholarly journals Changes in Nurse Staffing Grades of Korean Hospitals during COVID-19 Pandemic

2021 ◽  
Vol 18 (11) ◽  
pp. 5900
Author(s):  
Young-Taek Park ◽  
JeongYun Park ◽  
Ji Soo Jeon ◽  
Young Jae Kim ◽  
Kwang Gi Kim
Keyword(s):  
Generalized Linear Model ◽  
Nurse Staffing ◽  
Staffing Level ◽  
Important Indicator ◽  
Independent Variables ◽  
Staffing Levels ◽  
Number Of Patients ◽  
Nurse Staffing Level ◽  
General Wards

The global COVID-19 pandemic is creating challenges to manage staff ratios in clinical units. Nurse staffing level is an important indicator of the quality of care. This study aimed to identify any changes in the nurse staffing levels in the general wards of hospitals in Korea during the COVID-19 pandemic. The unit of analysis was the hospitals. This longitudinal study observed the quarterly change of the nurse staffing grades in 969 hospitals in 2020. The nurse staffing grades ranged from 1 to 7 according to the nurse–patient ratio measured by the number of patients (or beds) per nurse. The major dependent and independent variables were the change of nurse staffing grades and three quarterly observation points being compared with those during the 1st quarter (1Q) of 2020, respectively. A generalized linear model was used. Unexpectedly, the nurse staffing grades significantly improved (2Q: RR, 27.2%; 95% confidence interval (CI), 15.1–27.6; p < 0.001; 3Q: RR, 95% CI, 20.2%; 16.9–21.6; p < 0.001; 4Q: RR, 26.6%; 95% CI, 17.8–39.6; p < 0.001) quarterly, indicating that the nurse staffing levels increased. In the comparison of grades at 2Q, 3Q, and 4Q with those at 1Q, most figures improved in tertiary, general, and small hospitals (p < 0.05), except at 3Q and 4Q of general hospitals. In conclusion, the nurse staffing levels did not decrease, but nursing shortage might occur.

scholarly journals Impact Of Nurse Unionization On Fiscal Viability And Selected Measures Of Quality In Hospitals

2011 ◽  
Vol 6 (3) ◽  
Author(s):  
Jim Morey ◽  
Gary Scherzer ◽  
Hoseoup Lee ◽  
Kenneth Wallis ◽  
Laura Francis Gladney
Keyword(s):  
New York ◽  
Quality Of Care ◽  
Institutional Care ◽  
Nurse Staffing ◽  
Financial Variables ◽  
Staffing Levels ◽  
Union Status ◽  
The Impact ◽  
The Relationship

<p class="MsoNormal" style="margin: 0in 0.5in 0pt;"><span style="font-size: 10pt;"><span style="font-family: Times New Roman;">Seventy-three New York hospitals were examined to determine if a difference existed between hospitals with nursing unions versus those without as it pertains to fiscal viability and quality of care.<span style="mso-spacerun: yes;">&nbsp; </span>Several financial variables were used to construct a fiscal viability index; and a quality index was created from selected mortality and procedural measures that may be used to measure specific aspects of institutional care.<span style="mso-spacerun: yes;">&nbsp; </span>The premise that the union status of a hospital&rsquo;s nursing staff will influence fiscal viability and quality is based on the impact that unionization may have on staffing and cost per patient.<span style="mso-spacerun: yes;">&nbsp; </span>The literature is replete with studies that assess the relationship between nurse staffing levels and quality.<span style="mso-spacerun: yes;">&nbsp; </span>In some cases there is a clear and compelling relationship, but in others, it is indeterminate. <span style="mso-spacerun: yes;">&nbsp;</span>Utilizing union status, selected employee variables, and financial and quality of care indices, four statistical models were prepared to explain these the interaction of these variables <span style="mso-spacerun: yes;">&nbsp;</span></span></span></p>

scholarly journals Nurse Staffing and Nursing Home Deficiency of Care for Inappropriate Psychotropics Use in Residents With Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 207-208
Author(s):  
Jung Min Yoon ◽  
Alison Trinkoff ◽  
Carla Storr ◽  
Elizabeth Galik
Keyword(s):  
Mixed Models ◽  
Psychological Symptoms ◽  
Nurse Staffing ◽  
Skill Mix ◽  
Staffing Ratios ◽  
Staffing Levels ◽  
Nurse Aide ◽  
Nursing Staffing ◽  
Behavioral And Psychological Symptoms ◽  
Reporting Data

Abstract Psychotropics use to manage behavioral and psychological symptoms of dementia (BPSD) in nursing homes (NHs) has been the focus of policy attention due to their adverse effects. We hypothesized that NHs with lower nursing staffing would have greater reliance on psychotropics use to control BPSD. A NH deficiency of care can be cited for inappropriate psychotropics use (F-tag 758). The association between the occurrence of F-758 tags and nurse staffing in residents with dementia was examined using the 2017-18 Certification and Survey Provider Enhanced Reporting data (n=14,548 NHs). Staffing measures included nursing hours per resident day (HPRD) and registered nurse (RN) skill-mix. Generalized linear mixed models that included covariates (NH location, bed size, ownership, proportion of residents with dementia/depression/psychiatric disorders and with Medicare/Medicaid) estimated the magnitude of the associations. There were 1,872 NHs with F-758 tags indicating inappropriate psychotropics use for NH residents with dementia. NHs with greater RN and certified nurse assistant (CNA) HPRD had significantly lower odds of F-758 tags (OR=0.59 54, 95% CI=0.47 44-0.73 66; OR=0.87, 95% CI=0.77-0.99, respectively) and similar findings were found in NHs with greater RN skill-mix (OR=0.14 10, 95% CI=0.05 04-0.37 25). There were no significant associations between the occurrence of F-758 tags and licensed practice nurse and unlicensed nurse aide HPRD. This study found that RN and CNA staffing had inverse associations with inappropriate psychotropic use citations among residents with dementia. NHs with higher RN staffing ratios may be better able to implement alternatives to pharmacological approaches for BPSD. It is suggested that NHs be equipped with adequate nurse staffing levels to reduce unnecessary psychotropics use.

Evaluation of Ceiling Lifts in Health Care Settings

AAOHN Journal ◽  
2009 ◽  
Vol 57 (9) ◽  
pp. 374-380 ◽  
Author(s):  
Hasanat Alamgir ◽  
Olivia Wei Li ◽  
Erin Gorman ◽  
Catherine Fast ◽  
Shicheng Yu ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Care ◽  
Pressure Ulcer ◽  
Care Facility ◽  
Care Quality ◽  
Patient Perceptions ◽  
Term Care ◽  
Health Care Settings ◽  
The Relationship

Ceiling lifts have been introduced into health care settings to reduce manual patient lifting and thus occupational injuries. Although growing evidence supports the effectiveness of ceiling lifts, a paucity of research links indicators, such as quality of patient care or patient perceptions, to the use of these transfer devices. This study explored the relationship between ceiling lift coverage rates and measures of patient care quality (e.g., incidence of facility-acquired pressure ulcers, falls, urinary infections, urinary incontinence, and assaults [patient to staff] in acute and long-term care facilities), as well as patient perceptions of satisfaction with care received while using ceiling lifts in a complex care facility. Qualitative semi-structured interviews were used to generate data. A significant inverse relationship was found between pressure ulcer rates and ceiling lift coverage; however, this effect was attenuated by year. No significant relationships existed between ceiling lift coverage and patient outcome indicators after adding the “year” variable to the model. Patients generally approved of the use of ceiling lifts and recognized many of the benefits. Ceiling lifts are not detrimental to the quality of care received by patients, and patients prefer being transferred by ceiling lifts. The relationship between ceiling lift coverage and pressure ulcer rates warrants further investigation.

scholarly journals Value-Based HIV Care: A Method to Improve Quality of HIV Care.

2020 ◽  
Author(s):  
Guido van den berk ◽  
Daoud Ait Moha ◽  
Janneke Stalenhoef ◽  
Marie-Jose Kleene ◽  
Narda van der Meche ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Care Delivery ◽  
Population Level ◽  
Care Quality ◽  
Hiv Care ◽  
First Year ◽  
Outcome Indicators ◽  
Number Of Patients ◽  
Care Path

Abstract Background : To support our goal of providing optimal HIV care to our patients, we started applying the value-based health care principle to the HIV care that we offer in our HIV center, measuring relevant health outcomes and costs to allow continuous implementation of improvements (Value-Based HIV Care; VBHiC). Methods : In line with the principles of Michael Porter, our approach consisted of the following steps: 1) Organizing into integrated practice units / describing the HIV care path; 2) Defining an HIV outcome indicator set; 3) Building an enabling information technology platform; 4) Integrating care delivery across separate facilities; 5) Moving to bundled payments for care cycles and 6) Expanding excellent services and interventions for improvement across geographic boundaries. Results : The following set of 9 outcome indicators was developed: undetectable HIV load within the first year of care; quality of life within the first year of care; mortality within the first year of care; retention in care; therapy effectiveness; therapy tolerance; cardiovascular risk; quality of life for every subsequent year and overall annual mortality. These indicators, which were evaluated retrospectively, are shown in figures 1-5. Collection of the underlying data started in January 2016. The HIV care path was also integrated into the electronic file system. Creation of the ability to monitor outcome indicators at patient level, population level and process level allowed us to implement a quality cycle (plan-do-study-act). Conclusion : Our Value-Based HIV Care approach facilitated structured evaluation of parameters that are of value to the patient. It also boosted the quality of the HIV care that we provide and allowed us to increase the number of patients to whom we can offer high quality HIV care.

The Power of Words

2017 ◽  
pp. 1100-1120
Author(s):  
Sarah Bigi ◽  
Giulia Lamiani
Keyword(s):  
Decision Making ◽  
Patient Engagement ◽  
Medical Condition ◽  
Normative Model ◽  
Patient Interactions ◽  
Training Materials ◽  
Power Of Words ◽  
The Relationship ◽  
Improve Patient

The concept of patient engagement is attracting growing attention from scholars working on doctor-patient interactions. It refers to the condition in which patients are fully aware of their medical condition and willing to be active both in the relationship with their caregivers and towards the health care institutions. However, the operative steps necessary to achieve patient engagement have not yet been fully described. This chapter focuses on the communicative dimension of engagement. Communication is shown to be a pivotal means to improve patient self-efficacy and commitment, both fundamental components of engagement. In particular, the authors take a closer look at the process of decision making in chronic care settings, and propose a normative model to analyze and evaluate the quality of decision making in consultations. It is argued that the model can also be used as a blueprint to create training materials for clinicians.

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